Keep Britain Working, explained for small employers.

Update · 23 September 2026

Britain's first Workplace Health System. Sir Charlie Mayfield's September update sets out a Workplace Health System with three parts: better, more inclusive workplaces; better Workplace Health Provision, built around an impartial case manager; and better intelligence, which the update calls "the engine". It lists the first specific employer commitments being tested, including a conversation within 5 working days of an issue being raised and a stay-in-work plan with named actions and owners, and describes a prototype Work and Health Toolkit being built with the University of Liverpool. More than 200 Vanguard organisations and eleven regional Vanguards are testing it.

Source: GOV.UK, Keep Britain Working: a national growth opportunity, September 2026, published 23 September 2026.

Update · September 2026

Three things moved over the summer. The health MOT now has an official name: the government's June 2026 progress update calls it a Work and Health Check, introduced "at key points across the employment lifecycle", with a phased rollout "starting with larger employers or specific regions". The standard has a timetable: BSI's drafting panel is in place, chaired by Valerie Todd, and BSI expects a draft for public comment in early 2027. And the Vanguard employers intend to publish best practice guidelines by the end of 2026, which Legal & General's Vanessa Sallows says must be "accessible and scalable and available to all employers of all sizes".

Sources: GOV.UK, Keep Britain Working: the story so far (June 2026), published 3 July 2026 and updated 4 August 2026; BSI press release, 31 March 2026; Health & Protection, 7 September 2026.

Keep Britain Working is a UK government review led by Sir Charlie Mayfield, the former chairman of the John Lewis Partnership. It was commissioned to tackle one of the country's most pressing economic problems: the number of people leaving work because of ill health. Its central argument is simple. The system has been organised around helping people after they get ill or fall out of work. It should instead be organised around earlier action that keeps people healthy and in work in the first place.

The programme has been developed with more than 250 employers, providers and organisations, and by mid-2026 nearly 200 workplaces had signed up as "Vanguards" to test what works. The programme is now in its Vanguard Phase: a three-year partnership with volunteer employers of every size, which means small employers are explicitly in scope, not an afterthought. Most of those are large employers. The practical detail for small firms, which is where this guide comes in, has had far less attention.

The scale of the problem is the reason this review has moved quickly and has cross-department backing. The headline figures the government has put behind it:

The problem	The number
People economically inactive due to ill health	2.8 million
Estimated annual cost to the UK economy	around £212bn (~7% of GDP)
Of which, annual cost to employers	around £85bn
Workplaces signed up as Vanguards	nearly 200

Source: GOV.UK, Department for Work and Pensions, Keep Britain Working review final report (Sir Charlie Mayfield), November 2025.

The government's own assessment is that sickness absence is tracked inconsistently and that the success of return-to-work efforts is rarely measured. In other words, the country cannot manage what it cannot see. That is the gap the Workplace Health Intelligence Unit is designed to close.

The Workplace Health Intelligence Unit is a new body announced in July 2026 that will collect standardised data from employers and providers across the UK. It will track sickness absence, return-to-work outcomes and disability participation, with the stated aim of making workplace health performance visible for the first time, enabling benchmarking, and shifting the focus firmly towards prevention.

The government's June 2026 progress update sets out seven functions for the Unit, from standard setting and collection through to benchmarking and evidence-based policy, and describes it as "central" to the programme's data work. For employers, the direction of travel is clear: measuring workforce health is moving from a nice-to-have to an expectation. We list the seven functions and what they mean for a small firm in a dedicated guide: What is the Workplace Health Intelligence Unit?

Two further ideas sit alongside the Unit. The first is a new national accreditation standard, the Healthy Working Standard, for employers who offer a certain level of workplace health provision, set at a level meant to be affordable. It grows out of a five-stage "healthy working lifecycle" (recruitment and onboarding, healthy in work, unwell in work, absence and return to work, and exit or re-employment) and is expected to become a formal standard by around 2029. The second is a proposed staff health check, which the government now calls a Work and Health Check and the press calls a health MOT: introduced "at key points across the employment lifecycle", initially at onboarding and at trigger points such as periods of absence, modelled on approaches used in countries such as Japan and Finland. The government says a phased rollout "starting with larger employers or specific regions, is likely to be needed".

Both are still being developed rather than finalised. But both point the same way: employers being expected to offer, and evidence, a baseline of workplace health support.

If you run a 20, 50 or 150-person company, the temptation is to assume this is aimed at the Tescos and the PwCs. It is not only aimed at them. The whole point of the review is that prevention has to reach the firms where most people actually work, and small firms are precisely where support is thinnest: no occupational health, often no dedicated HR, and no easy way to capture the data the system will increasingly expect.

There is an upside hiding in that. The barrier for small firms has always been cost and complexity. The review itself frames good workplace health as something achievable "without large up-front investment". That is the opening. You do not need an enterprise budget to start measuring how your people are doing and to show you are acting on it.

The first gap is simply knowing about it. Research published by GRiD, the group risk industry body, in July 2026 found 86% of large employers (250 or more staff) were aware of the review, against 45% of micro businesses with one to ten staff. The programme itself is trying to close that gap: the June 2026 update commits that any standard will be "feasible, accessible and proportionate for all employers, particularly including SMEs", and the government ran ten regional workshops with around 20 to 30 small and medium-sized firms each. Small firms are in the brief. They are just the last to hear about it.

You cannot implement a standard that has not been published yet. But you can get ahead of the direction of travel, and everything the review points to starts from the same two things: measuring how your people are really doing, and being able to evidence that you are acting on it. Three practical moves:

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